来氟米特配伍雷公藤多甙治疗难治性肾病综合征的疗效观察

目的：观察来氟米特联合雷公藤多甙治疗难治性肾病综合征（RNS）的疗效。方法：选取52例RNS患者随机分为观察组（32例）与对照组（30例）,其中对照组给予来氟米特和激素联合治疗,观察组给予来氟米特配伍雷公藤多甙治疗。疗程均为6个月,治疗期间比较两组疗效,检测患者24h尿蛋白定量、血清总蛋白和白蛋白、血肌酐、血尿素氮、谷丙转氨酶变化情况,同时观察患者有无不良反应。结果：①治疗6个月后,观察组完全缓解率和总有效率分别为28.13%、78.13%,略高于对照组26.67%的完全缓解效率和76..67%的总有效率,但两组间差异无统计学意义（P〉0.05）。②经过治疗,RNS患者24h尿蛋白定量逐渐下降,而血清总蛋白和白蛋白水平逐渐增加,与治疗前比较差异均有显著性（P〈0.01）,其中观察组各指标变化比对照组明显（P〈0.05）③治疗后观察组与对照组患者尿素氮、血肌酐含量均较治疗前显著降低（P〈0.01或0.05）,而谷丙转氨酶水平无明显变化（P〉0..05）,两组间差异无显著性（P〉0..05）。④观察组不良反应发生率为12.50%,明显低于对照组23.33%的发生率,组间差异有显著性（P〈0.05）。结论：米氟米特联合雷公藤多甙治疗能明显缓解RNS患者的临床症状,改善肾功能,减少蛋白尿的产生,且短期内不良反应较少。     

经纤维支气管镜灌洗治疗儿童顽固性肺炎的临床研究

目的:探讨经纤维支气管镜灌洗治疗儿童顽固性肺炎的治疗效果。方法:选择儿童顽固性肺炎患者48例,随机选择26例行纤维支气管镜灌洗治疗+常规治疗(实验组),另22例行单存常规治疗(对照组),对比两组治疗方案的有效率。结果:实验组22例(84.62%)有效,肺炎治疗有效时间为(9±2.1)d,对照组12例(54.55%)有效,肺炎治疗有效时间为(15.6±3.8)d。实验组肺炎治疗有效率明显高于对照组(p<0.05),且肺炎治疗有效时间明显少于对照组(p<0.05)。结论:纤维支气管镜灌洗是治疗儿童顽固性肺炎的一种有效方法。     

Frequency distribution of PRNP polymorphisms in the Pakistani population

Prion diseases are neurodegenerative conditions caused by misfolding of a normal host-encoded prion protein (PrP^C) into pathogenic scrapie prion protein (PrP^Sc). In human prion diseases, the M129V prion protein polymorphism is known to confer susceptibility to the disease, determines PrP^Sc conformation and alters clinicopathological phenotypes. To date, all clinicopathologically confirmed cases of a variant form of Cruetzfeldt-Jacob disease (vCJD) have been 129MM homozygotes. There is also predominance of 129MM homozygotes in sporadic CJD (sCJD). No information regarding prion disorders is available from Pakistan. Although only invasive procedures like brain biopsy can confirm the diagnosis of prion disorders, testing a corresponding human population for variation in the prion protein gene (PRNP) may provide some insights into the presence of these disorders in a locality. The current study therefore aimed at exploring the genetic susceptibility of Pakistani population to CJD. A total of 909 unrelated individuals including 221 hemophiliacs representing all 4 major provinces of Pakistan were screened for M129V polymorphism and insertions or deletions of octapeptide repeats (OPRIs/OPRDs) using Polymerase Chain Reaction coupled with Restriction Fragment Length Polymorphism (PCR-RFLP). Concordance of the results of some PCR-RFLP reactions was also confirmed by dideoxy automated Sanger sequencing. The frequencies of M129V alleles (129M and 129V) and genotypes (129MM, 129MV and 129VV) were found in all 909 individuals to be 0.7101, 0.2899, 0.5270, 0.3663 and 0.1067, respectively. Deletion of 1 octapeptide repeat (1-OPRD) was detected in heterozygous state in PRNP of 10 individuals and in homozygous state in 1 individual. An insertion of 3 octapeptide repeats (3-OPRI) was found in 1 individual and an insertion of 1 octapeptide repeat (1-OPRI) in two individuals. Both 3-OPRI and 1-OPRI were present in heterozygous state and were linked to 129M allele. There were no significant χ² differences between M129V allelic and genotypic frequencies of healthy individuals and hemophiliacs. However, M129V allelic and genotypic frequencies differed significantly between Pakistani population and East Asian and Western populations. Non-significant χ² differences between M129V frequencies of healthy individuals and hemophiliacs suggest that individuals manifesting single gene disorders may provide naturally randomized samples for studies aiming at surveying the genetic variation. The combined excess of 129MM and 129VV homozygosity and the presence of 3-OPRI in 1 individual imply that Pakistani population is susceptible to prion disorders. Cases of prion disorders may exist in Pakistan, albeit at lower annual prevalence than other countries where life expectancy is greater than 65 years.     

Applying DNA barcodes for identification of plant species in the family Araliaceae

Genetic variants of tPA (PLAT) and PAI-1 genes have been suggested to be the risk factors for stroke. In the present case-control study we investigated the association of − 7351 C/T polymorphism (rs2020918) and I/D polymorphism of tPA gene and Insertion/deletion polymorphism (4 G/5 G) of PAI-1 gene with genetic predisposition to ischemic stroke. 516 stroke patients and 513, sex and age matched healthy controls were involved in the study. We did not find a significant association of tPA − 7351 C/T polymorphism and PAI-1 4 G/5 G polymorphism with stroke. However, in case of I/D polymorphism significant difference was observed in the genotypic distribution and allelic frequency between the stroke patients and healthy controls. DD genotype and D allele associated significantly with stroke (p = 0.002 and < 0.001 respectively). We also found significant association of I/D polymorphism with intracranial large artery atherosclerosis and stroke of undetermined etiology. Exploring the association between gene-gene interaction (26 combinations including the three variants) and stroke, we found that individuals with CC + 4G4G + DD, CC + 5G5G + ID, CT + 4G5G + ID, CT + 5G5G + II, CT + 5G5G + ID and TT + 4G5G + II had a significantly higher risk of stroke. The results of this study suggest that − 7351 C/T polymorphism of tPA and 4 G/5 G polymorphism of PAI-1 are not associated with stroke, while as DD genotype and D allele of tPA gene are important risk factors for ischemic stroke. Further we found that the subjects with different tPA and PAI genotype combinations displayed a significantly high risk for overall ischemic stroke suggesting that gene-gene interaction involving more variants may change the susceptibility of particular subjects to the disease.     

Intestinal microbiota and secretory immunoglobulin A in feces of exclusively breast-fed infants with blood-streaked stools

Episodes of blood‐streaked stools are not uncommon in exclusively breast‐fed infants under 6 months of age. Such bleeding is thought to be associated with food protein‐induced proctocolitis, however the pathomechanism remains unclear. The aim of this study was to investigate intestinal microbiota and secretory immunoglobulin A in the feces of exclusively breast‐fed infants with blood‐streaked stools. Fecal specimens from 15 full‐term infants with blood‐streaked stools and 15 breast‐fed healthy infants were studied and the results compared. All infants had been delivered vaginally and exclusively breast‐fed. The fecal microbiota were investigated by phylogenetic analysis combined with culture methods for some bacterial species, and feces were assessed for the presence of fecal secretory immunoglobulin A by enzyme‐linked immunosorbent assay. Phylogenetic cluster analysis revealed four major clusters of fecal bacteria, cluster A being found only in healthy infants. The Bacteroides fragilis group was observed more frequently in controls than in patients (P < 0.05). In the controls, the predominant species belonging to the Enterobacteriaceae group was Escherichia coli, whereas in the patients it was Klebsiella (P < 0.05). Concentrations of secretory immunoglobulin A were high in one third of the healthy controls. In conclusion, the pathomechanism of rectal bleeding in exclusively breast‐fed infants may be related to differences in the composition of their intestinal flora.     

清热散结片联合阿维A胶囊治疗难治性银屑病的疗效及对炎症反应的影响

目的:分析清热散结片联合阿维A胶囊治疗难治性银屑病的疗效,并探讨其对炎症反应的影响。方法:选择2013年3月-2016年3月我院收治的100例难治性银屑病患者作为研究对象,按照随机数字表法分为对照组和观察组,每组各50例;对照组给予口服阿维A胶囊,观察组在对照组的基础上给予口服清热散结片;对比两组的临床疗效及不良反应发生情况,检测治疗前后血清肿瘤坏死因子(TNF-α)、白细胞介素-8(IL-8)及白细胞介素-4(IL-4)水平变化。结果:观察组的总有效率为96.00%(48/50),显著高于对照组的84.00%(42/50),差异有统计学意义(P0.05);治疗前两组TNF-α、IL-8及IL-4的水平对比,差异无统计学意义(P0.05),治疗后两组TNF-α、IL-8及IL-4水平均有所降低,且观察组显著低于对照组,差异有统计学意义(P0.05);治疗期间,两组无严重不良反应,差异无统计学意义(P0.05)。结论:清热散结片联合阿维A胶囊治疗难治性银屑病的疗效显著,能够明显缓解患者机体的炎性反应,值得临床推广应用。     

急诊断流术在门静脉高压症并食道胃底静脉出血的疗效观察

目的观察急诊断流术在门静脉高压症并食道胃底静脉出血的临床疗效。方法选取我院收治的门静脉高压症并食道胃底静脉出血患者103例,随机分为两组。对照组52例,在患者入院后先采取保守止血治疗,再择期进行断流术;观察组51例,在患者入院后立即采取急诊断流术治疗。观察比较两组的临床疗效。结果观察组患者术后死亡率为11.76%,对照组为25.00%,两组比较差异有统计学意义(P0.05)。观察组患者住院时间短于对照组,差异有统计学意义(P0.05)。经随访3~4年,观察组再次出血发生率为12.76%,对照组再次出血发生率为13.46%,两组比较差异无统计学意义(P0.05)。结论急诊断流术在门静脉高压症并食道胃底静脉出血的临床疗效显著,可降低患者死亡率,缩短住院时间,值得临床应用。     

环孢素A对难治性免疫性血小板减少性紫癜的辅助治疗

目的探讨环孢素A辅助治疗难治性免疫性血小板减少性紫癜(ITP)的临床疗效及对患者血小板计数和细胞因子的影响。方法选择2013年1月至2016年12月期间浙江省金华市人民医院收治的难治性ITP患者78例。按照随机数字表分为观察组39例与对照组39例。对照组患者给予利妥昔单抗治疗,观察组在对照组基础上结合环孢素A辅助治疗,两组患者疗程均为3个月。比较两组患者的疗效,治疗前后血小板计数变化,血小板恢复正常时间,治疗前后细胞因子变化及不良反应发生情况。结果观察组患者治疗总有效率(92.31%)高于对照组(69.23%),差异有统计学意义(χ2=6.6857,P0.05);两组患者治疗后血小板计数增加,观察组患者治疗后血小板计数高于对照组、血小板恢复正常时间低于对照组,差异均有统计学意义(t=20.6717、8.1189,P0.05);两组患者治疗后IFN-γ水平较治疗前降低,IL-4、IL-10水平升高,差异有统计学意义(观察组:t=22.9522、11.7500、11.9032,对照组:t=9.8537、7.2250、6.7012,P0.05),且治疗后观察组患者IFN-γ水平低于对照组,IL-4、IL-10水平高于对照组,差异有统计学意义(t=13.0096、3.8277、4.7989,P0.05);两组患者不良反应发生率比较差异无统计学意义(χ2=0.0000,P0.05)。结论环孢素A辅助治疗难治性ITP患者疗效显著,且可增加患者血小板数量,降低IFN-γ水平,增加IL-4、IL-10水平,提高患者免疫力。     

Anticancer efficacy of p-dodecylaminophenol against high-risk and refractory neuroblastoma cells in vitro and in vivo

Neuroblastoma is an aggressive and drug-resistant refractory cancer. The human high-risk neuroblastoma cell line, SK-N-AS (non-amplified N-myc) is derived from stromal cells and it is resistant to treatment with retinoic acid (1, RA), which is a chemotherapeutic agent used to induce neuronal cellular differentiation of neuroblastomas. We have developed p-dodecylaminophenol (3, p-DDAP), based on N-(4-hydroxyphenyl)retinamide (2, 4-HPR), a synthetic amide of 1, since 1 and 2 are associated with the side-effect of nyctalopia. In order to evaluate the effects of 3 on high-risk neuroblastomas, we employed SK-N-AS cells as well as a second high-risk human neuroblastoma cell line, IMR-32, which is derived from neuronal cells (amplified N-myc, drug sensitive). Compound 3 suppressed cell growth of SK-N-AS and IMR-32 cells more effectively than 1, 2, p-decylaminophenol (4, p-DAP), N-(4-hydroxyphenyl)dodecananamide (5, 4-HPDD) or N-(4-hydroxyphenyl)decananamide (6, 4-HPD). In SK-N-AS cells, 3 induced G₀/G₁ arrest and apoptosis to a greater extent than 1 and 2. In IMR-32 cells, 3 induced apoptosis to a similar extent as 1 and 2, potentially by inhibiting N-myc expression. In addition, i.p. administration of 3 suppressed tumor growth in SK-N-AS-implanted mice in vivo. Since 3 showed no effects on blood retinol concentrations, in contrast to reductions following the administration of 2, it exhibited excellent anticancer efficacy against high-risk neuroblastoma SK-N-AS and IMR-32 expressing distinct levels of N-myc. Compound 3 may have potential for clinical use in the treatment of refractory neuroblastoma with reduced side effects.     

The mechanisms of refilling of xylem conduits and bleeding of tall birch during spring

Seasonal variations in osmolality and components of xylem sap in tall birch trees were determined using several techniques. Xylem sap was extracted from branch and trunk sections of 58 trees using the very rapid gas bubble-based jet-discharge method. The 5-cm long wood pieces were taken at short intervals over the entire tree height. The data show that large biphasic osmolality gradients temporarily exist within the conducting xylem conduits during leaf emergence (up to 272 mosmol x kg(-1) at the apex). These gradients (arising mainly from glucose and fructose) were clearly held within the xylem conduit as demonstrated by (1)H NMR imaging of intact twigs. Refilling experiments with benzene, sucrose infusion, electron and light microscopy, as well as (1)H NMR chemical shift microimaging provided evidence that the xylem of birch represents a compartment confined by solute-reflecting barriers (radial: lipid linings/lipid bodies; axial: presumably air-filled spaces). These features allow transformation of osmolality gradients into osmotic pressure gradients. Refilling of the xylem occurs by a dual mechanism: from the base (by root pressure) and from the top (by hydrostatic pressure generated by xylem-bound osmotic pressure). The generation of osmotic pressure gradients was accompanied by bleeding. Bleeding could be observed at a height of up to 21 m. Bleeding rates measured at a given height decreased exponentially with time. Evidence is presented that the driving force for bleeding is the weight of the static water columns above the bleeding point. The pressure exerted by the water columns and the bleeding volume depend on the water-filling status of (communicating) vessels.